gms | German Medical Science

Objective: Today, decompressive craniectomy (DCC) in patients with increased intracranial pressure after head trauma and stroke is widely accepted and frequently performed, with the consequence that the number of cranioplasties is increasing as well. Many studies focussed on DCC addressing operative technique, timing, and patient selection, but cranioplasty after DCC found hardly any scientific interest. As we gained the impression of a high rate of unsatisfactory results after cranioplasty with autologous bone, we performed a study to evaluate our clinical results.

Methods: Our data bank was screened for patients, who underwent DCC as well as cranioplasty between 2003 and 2006. The files of the identified patients were re-assessed for postoperative course and complications. For cranioplasty, the bone flap which was frozen at -80° C in an aseptic container was defrosted and re-implanted. Sutures as well as plates were used for fixation of the flap.

Results: 104 patients underwent cranioplasty in the last 3 years. In 59 of those patients, cranioplasty following DCC for head trauma using the harvested bone flap was performed. 20 of the 59 patients (30%) underwent re-operation, most of them because of infectious complications: infection of the bone flap (n=10), necrosis/chronic osteomyelitis of the skull (n=4). No relation could be found between infection and the method of bone flap fixation (rigid with plates, semirigid with sutures). Other complications (epi-, subdural hematoma, hydrocephalus) were rare.

Conclusions: Cranioplasty after DCC using the autologous bone flap is not a difficult operation, but carries a high risk of complications. Especially infectious complications are frequent, irrespective of the used method of bone flap fixation. Possibly, better results could be obtained if heterologous materials are used from the start.